MEDICARE: MULTI SPECIALTY MEDICAL GROUP PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	2084N0400X	Neurology Physician
3	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1487530226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTI SPECIALTY MEDICAL GROUP PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1318 E FLORENCE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90001-1935
Country	:	US
Telephone Number	:	213-583-4066
Fax Number	:	213-554-1387

Provider Business Practice Location Address
First Line	:	1318 E FLORENCE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90001-1935
Country	:	US
Telephone Number	:	213-583-4066
Fax Number	:	213-554-1387

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	LAWRENCE MORA
Credential	:	MD
Telephone Number	:	213-583-4066

Provider Enumeration Date	:	08/15/2025
Last Update Date	:	09/10/2025

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